More than Just Skin-Deep: A Review of Imaging's Role in Guiding CAR T-Cell Therapy for Advanced Melanoma

Sep 24, 2026

Uploaded by Jiven

Advanced melanoma is a highly lethal malignancy driven by invasiveness and frequent therapeutic resistance. While surgery is often feasible for early-stage tumors, advanced disease limits curative options and yields poor outcomes with chemotherapy. Building on CAR T-cell success in hematologic cancers, clinical trials are extending CAR T therapy to advanced melanoma. This review evaluates current imaging approaches, including novel PET tracers and radiomics, to guide CAR T-cell treatment and manage potential adverse events.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages20

Reading Time50 min

AccessFree to download

Introduction

Clinical Setting of Melanoma

Current Limitations of Therapies for Advanced Melanoma

diagnostics Review More than Just Skin-Deep: A Review of Imaging's Role in Guiding CAR T-Cell Therapy for Advanced Melanoma Conor M. Prendergast 1, Kathleen M. Capaccione 1, Egesta Lopci 2, Jeeban P. Das 3, Alexander N. Shoushtari 3, Randy Yeh 3, Daniel Amin 1, Laurent Dercle 1 and Dorine De Jong 3, * Citation: Prendergast, C.M.; Capaccione, K.M.; Lopci, E.; Das, J.P.; Shoushtari, A.N.; Yeh, R.; Amin, D.; Dercle, L.; De Jong, D. More than Just Skin-Deep: A Review of Imaging's Role in Guiding CAR T-Cell Therapy for Advanced Melanoma. Diagnostics 2023, 13, 992. [https://doi.org/](https://doi.org/)[ ](https://doi.org/)[10.3390/diagnostics13050992](10.3390/diagnostics13050992) Academic Editor: Dario Marchetti Received: 1 February 2023 Revised: 21 February 2023 Accepted: 24 February 2023 Published: 5 March 2023 Copyright: © 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ([https://](https://)[ ](https://)[creativecommons.org/licenses/by/](creativecommons.org/licenses/by/)[ ](creativecommons.org/licenses/by/)[4.0/](4.0/)) . 1 Department of Radiology, Columbia University Irving Medical Center, New York, NY 10032, USA 2 Department of Nuclear Medicine, IRCSS Humanitas Research Hospital, 20089 Milan, Italy 3 Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA * Correspondence: [dejongd@mskcc.org](dejongd@mskcc.org) Abstract: Advanced melanoma is one of the deadliest cancers, owing to its invasiveness and its propensity to develop resistance to therapy. Surgery remains the ﬁrst-line treatment for early-stage tumors but is often not an option for advanced-stage melanoma. Chemotherapy carries a poor prognosis, and despite advances in targeted therapy, the cancer can develop resistance. CAR Tcell therapy has demonstrated great success against hematological cancers, and clinical trials are deploying it against advanced melanoma. Though melanoma remains a challenging disease to treat, radiology will play an increasing role in monitoring both the CAR T-cells and response to therapy. We review the current imaging techniques for advanced melanoma, as well as novel PET tracers and radiomics, in order to guide CAR T-cell therapy and manage potential adverse events. Keywords: melanoma; CAR T-cell; metastases; radiomics; PET radiotracers; CAR T-cell imaging; radiology; CAR T-cell toxicity 1. Introduction Worldwide, incidences of melanoma have been increasing faster than nearly all other cancers across all age groups. Typically, primary melanoma is detected through physical and dermatological examination; however, it is a notoriously aggressive cancer (the deadliest form of skin cancer), and its metastases can invade nearly every organ system and carry a poor prognosis. Therefore, radiology plays an increasingly valuable role in detecting, prognosticating, and managing later stages of the disease. We will provide the most comprehensive review thus far of medical imaging's current and future role in advanced melanoma and discuss its expected role in guiding and monitoring CAR T-cell treatment for this disease. 1.1. Clinical Setting of Melanoma As with most skin cancers, the main risk factor for melanoma is ultraviolet radiation exposure. Exposure to ultraviolet rays causes DNA damage to cells, which leads to cellcycle arrest and apoptosis in normal cells, or abnormal proliferation and further mutation in cancer cells. Melanoma is currently ranked the sixth most common fatal cancer in the United States; this is expected to rise as population densities increase near the equator and with more frequent use of indoor tanning beds and outdoor activities. Fortunately, as for other skin cancers, the risk for melanoma can be easily lowered by minimizing time in the sun, avoiding exposure during peak hours, and applying sunscreen. Early-stage melanoma can be treated

FAQs

Why is imaging increasingly important in advanced melanoma?

Imaging supports detection, prognostication, and management as melanoma metastasizes across many organ systems, especially in later stages where treatment options expand beyond surgery.

What role does radiology play in CAR T-cell therapy for advanced melanoma?

Radiology is expected to monitor CAR T-cells and assess response to therapy, helping guide treatment decisions and manage potential adverse events.

Which advanced melanoma therapies are discussed as having limitations prior to newer approaches?

Before immunotherapy and targeted therapy, melanoma was treated using surgery and chemotherapy, and metastatic disease had poor surgical outcomes and dismal survival rates.

Sep 24, 2026

Uploaded by Jiven